Hospital Congestion using System Dynamics – Eric Wolstenholme

Hospital Congestion using System Dynamics – Eric Wolstenholme

Category : News , Presentation

Recently, Eric Wolstenholme gave a talk to the Health Special Interest Group of the System Dynamics Society exploring hospital congestion using system dynamics. In this talk, Eric outlines his current thinking on systems archetypes in the context of hospital congestion.

The talk is described as an exploration of cascaded and interlocking archetypes using a mixture of qualitative and quantitative system dynamics and a mix of theory and practice.

This talk will be of broad interest to system dynamicists and other modellers. It is available on the System Dynamics YouTube channel:

In addition, Eric has provided a synopsis of the Stella Architect story used in the presentation. Available at isee exchange: Further details are below.

Eric Wolstenholme was one of the pioneers of System Dynamics in the UK. He is a past President of the International System Dynamics Society and the UK Chapter; and received the Jay Wright Forrester Award in 2004 for his seminal work on generic system archetypes. He received the Outstanding Contribution Award from the UK SD chapter in 2019.

Ways of telling stories about Hospital Congestion

An exploration of cascaded and interlocking archetypes

In Eric’s own words:

On the back of numerous modelling studies around delayed hospital discharges in the UK, I have been exploring different ways of communicating the messy issue of hospital congestion. The communication problem arises from the complexity of both the number of coping strategies used by hospitals and the number of unintended consequences of each strategy. So, single causal maps become a bit impenetrable.

My first attempt involved showing both hospital coping strategies and their unintended consequences on stock flow maps (*). I then tried using individual system archetypes to describe the unintended consequences of each coping strategy (**). My latest attempt involves using generic archetypes (***) in tandem. I have named these ‘cascaded archetypes’, where the unintended consequence of one archetype becomes the driver for the next. The approach introduces each archetype in turn within an overall story. The pattern of each archetype (opportunity/threat-action-unintended consequence) provides structure and simplicity. Cascaded archetypes must always feedback on one another if they are part of the same system, so some interesting choices must be made between keeping each free-standing whilst showing important interlocking between archetypes. 

The presentation overviews my alternative approaches for describing hospital congestion and postulates a generic template for cascaded/interlocking archetypes. Please be prepared to try out the method on your own issues, particularly where unintended consequences are tackled by different stakeholders in different systems and where there might be all four of my generic archetypes (***) involved. The presentation is in Stella Architect and I have placed this on the isee systems exchange (see link below) so group members can access this now or later. (The story can be followed by pressing the space bar or pressing the buttons – at the end of each section or along the top of the screen.)


 *Wolstenholme, E. F., Arnold, S., Monk, D., Todd, D., & McKelvie, D. (2005). Coping but not coping in health and social care—masking the reality of running organisations well beyond safe design capacity. Systems Dynamics Review, 23(4), 371–389.

** Wolstenholme and McKelvie, The Dynamics of Care, Chapter 10. Springer 2019

*** Wolstenholme, E. F., Towards the definition and use of a core set of archetypal structures in system dynamics, System Dynamics Review, Vol. 19, No. 1 Spring, 2003.

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